Appendectomy by laparotomy, step by step

Appendectomy by laparotomy, step by step

1. Skin incision at McBurney's point
2. Opening Scarpa's fascia
3. Opening aponeurosis
4. Atraumatic spreading of muscle fibers
5. Identify and opening of peritoneum
6. Identify cecum and appendix
7. Deliver cecum and appendix
8. Identify and ligate appendiceal artery
9. Crush appendix at base
10. Ligate and remove appendix at base
11. If desired place a purse string suture around base of appendix
12. Closing peritoneum
13. Closing aponeurosis
14. Skin closure

Thats all...CHILL ;-)

Acute Appendicitis, General remarks

Classification Acute appendicitis has 6 types: 1. catarrhalis appendicitis; slightly red 2. phlegmonous: moderate inflammation and ischaemia 3. gangrenous: (partial) necrosis 4. perforated 5. appendicular mass 6. appendicular abscess

Treatment

In case of an acute appendicitis, an appendectomy should be performed, either by laparotomy or by laparoscopy. Fertile females should get a laparoscopy, to exclude any gynaecologic pathology. An appendicular mass should be treatment with medicine and other conservative measures (e.g. rest, no enteral nutrition)
Abscesses should be drained.

Antibiotics

All patients with an acute appendicitis should receive antibiotics. Normally the patient receives a single dose of antibiotics against gram-positive, gram-negative an anaerobes organisms. This treatment should be continued for 5 days in case of gangrenous and perforated appendicitis. In children a total of three days is sufficient.

Wondclosure

The skin can be closed entirely, and does not cause more wound-site infections compared to an approximating stitch. This also accounts for a perforated appendicitis.